Homebirth is Safer, Cheaper, and lowers the rates of Maternal Mortality

April 20, 2011

This is a portion of an excellent article about the social, economic, and health benefits of planned home birth, (or birthing in an alternative birth center).

In today’s system [in the US], 98 percent of mothers give birth in a hospital—the majority of them under the care of an obstetrician. One in every three births will occur surgically via cesarean section. Most women are lying in bed during their labor, without food or water, restricted by monitors strapped around their belly that measure fetal heart rates. The majority of women opt for an epidural, the spinal medication that numbs the body from the waist down. Inductions (provoking or encouraging labor progression with drugs like pitocin) are common practice.

We’ve arrived at this standard for childbirth care through a purposeful and calculated campaign on behalf of the medical establishment. Up until the early 20th century, childbirth always took place in the home, attended by midwives. In a span of about 30 years, doctors were able to convince women (and their husbands) that the hospital was the best place to give birth. The profession of midwifery was almost entirely eliminated in the U.S. through this campaign. Not only did doctors convince women to give birth with them in hospital, they also convinced the general public that birth at home was dangerous and risky—an idea that still prevails today, vigorously promoted by both the American Congress of Obstetricians and Gynecologists (ACOG) and the American Medical Association (AMA).

The idea of homebirth as risky and midwives as inadequate providers contrasted with the realities of the move from home to hospital for birth—maternal mortality rates actually increased in the first few decades that women began birthing in hospital.

Ina May Gaskin, a well-known midwife, explains in her new book “Birth Matters: A Midwife’s Manifesta” that this was due in part to lack of knowledge of disease transmission as well as lack of development in surgical techniques. She also explains that much of medical knowledge about childbirth and the female body was developed from autopsies on women who had died, rather than the observation of live women giving birth. The result was a rise in maternal and infant mortality in Washington, D.C., New York, New Jersey and Boston, all cities where more hospitals were established and, thus, where more births took place.

Meanwhile, hospital birth took a different path for women of color and low-income women than it did for white women with access to resources.

Before Medicaid was established in the 1960s, women of color and low-income women had little access to hospital birth because they couldn’t afford to pay for it. In the rural South, midwifery thrived until the ’70s and ’80s. Women of color in urban cities in the North moved into the hospitals more quickly, in part because laws outlawing midwives were enacted more quickly there and in part because the teaching hospitals in these areas wanted more birthing women to learn on. One doctor even paid immigrant women to birth at his Chicago hospital, according to Gaskin. Once Medicaid was enacted and provided reimbursement for obstetricians and hospital birth, it signaled the end of the midwifery era, as doctors made the final push to bring all of birth into their domain in the hospital now that they were guaranteed payment for the services.

Financial gain has long been a motivating factor at the root of the modern maternity care system— and it helps maintain the status quo today. Childbirth remains the number one cause of hospitalization for women in the U.S. A hospital birth will cost anywhere from $8,500 for an uncomplicated vaginal delivery to upwards of $20,000 for a c-section with complications. Taxpayers shoulder a significant portion of this burden, through the rising costs of programs like Medicaid, which cover the costs of millions of births each year. Meanwhile, many of those who have chosen (in increasing numbers) to give birth with a midwife at home often end up paying out of pocket for those services because many private insurance companies do not cover them.

Read the full article here.

{ 1 comment… read it below or add one }

cassia batts April 22, 2011 at 8:27 pm

how can we tell insurance companies to pay for the stuff that actually benefits us?? when are we going to be able to actually stand up to this? insurance companies should be the first ones on board – they won’t have to pay as much because there will be fewer problems, so they will still be making money! it’s just not fair :(

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